Neuropediatrics 2022; 53(02): 115-121
DOI: 10.1055/a-1739-2722
Original Article

Early-Onset Vascular Leukoencephalopathy Caused by Bi-Allelic NOTCH3 Variants

Menno D. Stellingwerff
1   Department of Child Neurology, Emma Children's Hospital, Amsterdam University Medical Centers, Vrije Universiteit and Amsterdam Neuroscience, Amsterdam, The Netherlands
,
Corinne Nulton
2   Department of Neurology, University of Pittsburgh Medical Center, Pennsylvania, United States
,
3   Translational Bioinformatics, Murdoch Children's Research Institute, The Royal Children's Hospital, Victoria, Australia
4   Genetics and Genomics, Institute for Molecular Bioscience, The University of Queensland, Queensland, Australia
,
Stefan D. Roosendaal
5   Department of Radiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
,
William S. Benko
6   Department of Neurology, University of California Davis, Sacramento, California, United States
,
Amy Pizzino
7   Division of Neurology, Children's Hospital of Philadelphia, Abramson Research Center, Philadelphia, Pennsylvania, United States
,
8   Department of Pathology, Amsterdam UMC, location VUmc, The Netherlands
,
Adeline Vanderver
7   Division of Neurology, Children's Hospital of Philadelphia, Abramson Research Center, Philadelphia, Pennsylvania, United States
9   Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
3   Translational Bioinformatics, Murdoch Children's Research Institute, The Royal Children's Hospital, Victoria, Australia
4   Genetics and Genomics, Institute for Molecular Bioscience, The University of Queensland, Queensland, Australia
,
Marjo S. van der Knaap
1   Department of Child Neurology, Emma Children's Hospital, Amsterdam University Medical Centers, Vrije Universiteit and Amsterdam Neuroscience, Amsterdam, The Netherlands
10   Department of Functional Genomics, Center for Neurogenomics and Cognitive Research, VU University, Amsterdam, The Netherlands
› Author Affiliations
Funding None.

Abstract

Objective Heterozygous NOTCH3 variants are known to cause cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), with patients typically presenting in adulthood. We describe three patients presenting at an early age with a vascular leukoencephalopathy. Genome sequencing revealed bi-allelic variants in the NOTCH3 gene.

Methods Clinical records and available MRI and CT scans of three patients from two unrelated families were retrospectively reviewed.

Results The patients presented at 9 to 14 months of age with developmental delay, seizures, or both. The disease course was characterized by cognitive impairment and variably recurrent strokes, migraine attacks, and seizures. MRI findings pointed at a small vessel disease, with extensive cerebral white matter abnormalities, atrophy, lacunes in the basal ganglia, microbleeds, and microcalcifications. The anterior temporal lobes were spared. Bi-allelic cysteine-sparing NOTCH3 variants in exons 1, 32, and 33 were found.

Interpretation This study indicates that bi-allelic loss-of-function NOTCH3 variants may cause a vascular leukoencephalopathy, distinct from CADASIL.

Authors' Disclosures

G.H. is supported by the Ochsner MD-PhD Scholarship. This study was in part financed by the Australian National Health and Medical Research Council (NHMRC 1068278) and the Medical Research Future Fund (ARG76368). The research conducted at the Murdoch Children's Research Institute was supported by the Victorian Government's Operational Infrastructure Support Program. M.B. receives research funding from ZonMw (VENI grant 016.196.107). A.V. receives research funding from the NIH U01 NS106845, U54NS115052, Eli Lilly, Biogen, Illumina, Takeda, Homology, Passage Bio, and Ionis. M.S.v.d.K. receives research funding from NWO (Spinoza award), ZonMw (TOP 91217006 and 10140261910004 / 80–86600–98–84001), Hersenstichting (DR-2019–00285), European Leukodystrophy Foundation (2019-P001 and 2020–017I2), Vanishing White Matter Foundation, Chloe Saxby and VWM Disease Incorporated, and VWM Families Foundation Inc. She has a patent P112686CA00, therapeutic effects of Guanabenz treatment in vanishing white matter, pending to VU University Medical Center. She is consultant for Calico.




Publication History

Received: 08 November 2021

Accepted: 12 January 2020

Accepted Manuscript online:
13 January 2022

Article published online:
23 February 2022

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